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Rabies Control: Three Months, Three Continents (Part 2 of 2)

Categories: infectious disease, rabies

   

September 28 is World Rabies Day, a global health observance that seeks to raise awareness about rabies and enhance prevention and control efforts. In the spirit of World Rabies Day, rabies program EIS Officer Ryan Wallace describes his travel around the world and how it affects global rabies prevention and control efforts. This is the second of a two-part series. Read Part 1.
 
 

The elusive EnKunga reportedly lives in small caves in Semuliki National Park, Uganda. This cave was empty.

The elusive EnKunga reportedly lives in small caves in Semuliki National Park, Uganda. This cave was empty.

 

PART 2 OF 2  

“Dr. Wallace, Taiwan is requesting immediate CDC assistance for a rabies outbreak. Can you fly out on Friday?”  

Ryan M. Wallace, DVM, MPH

Ryan M. Wallace, DVM, MPH

“Absolutely.”  

For the first time in over 50 years, rabies had reemerged in Taiwan. So I was on the move again. And in short order I would confront a gorge in Taiwan that plummets 3,000 meters (by comparison, the Grand Canyon is, on average, 1,600 meters deep). I’d develop a professional relationship with Taiwan Formosan ferret badgers and later, in Uganda, with what the locals refer to as EnKunga, “bats the size of goats.”  

Welcome to another day in CDC’s rabies program.  

Exotic as it is, the work is also important. Rabies is a devastating disease and its emergence in Taiwan was disturbing. Rabies is a neglected disease that kills more than 55,000 people each year worldwide. On World Rabies Day, September 28, it is important to encourage officials to advocate for rabies control and appropriate vaccination practices.  

That is why CDC got the call.  

Prior to 2013, only a handful of countries in the world were considered to be rabies-free. Taiwan was one of them.  

Rabies surveys in rural Uganda often required hours in the car, treacherous hiking, and fording rivers. All in a day’s work for your average EIS officer.

Rabies surveys in rural Uganda often required hours in the car, treacherous hiking, and fording rivers. All in a day’s work for your average EIS officer.

And then, in 2013, the list of rabies-free countries got shorter; two Formosan ferret badgers were diagnosed with the disease. In just a few short weeks after this initial diagnosis, over 100 rabid ferret badgers were identified from the southern two-thirds of the island. The rabies program at CDC assembled an expert team, and within days, four of us were flying to Taiwan.  

We were greeted with good news. Taiwan was able to assemble many highly qualified people to give their full attention to the disease. Surveillance systems were being implemented, human vaccine was ordered in bulk, and animal vaccination campaigns were under way. For the first few days, our job was to advise on how to best direct resources.  

With the urgency subsiding, we were asked to travel to five cities affected by rabies to assess the environment and advise local public health officials on rabies control methods. For the next week, we spent mornings with local stakeholders and afternoons climbing mountains to reach ferret badger habitats.  

We placed trail cameras and placebo vaccine baits on forested mountaintops to determine which bait the ferret badgers were most fond of eating and thus, the best type of oral rabies vaccine to use.  

We even visited a rescue center for ferret badgers and filmed them choosing their preferred rabies vaccine bait flavor (it turns out they are quite picky eaters).  

EIS Officers Laura Adams and Ryan Wallace found that local health officials, including vector control officers, were vital to identifying populations at risk of exposure to rabies reservoir species in Uganda.

EIS Officers Laura Adams and Ryan Wallace found that local health officials, including vector control officers, were vital to identifying populations at risk of exposure to rabies reservoir species in Uganda.

Each day after field work, we joined our Taiwan collaborators in the local customs of sorghum liquor and the strangest, but somehow most delicious food I have ever tasted. Suffice to say, no part of the animal goes to waste. If ever you find yourself in Taiwan, under the tutelage of a tall, wild-haired professor (and the world’s only Formosan ferret badger expert), do NOT ask what you are eating. Just close your eyes and enjoy.  

The investigation was capped by a tour of the Taroka Gorge, a 3,000-meter deep gorge separating the northern third of the island from the south. It is assumed to be a natural barrier to disease spread in Taiwan. To date, no rabid ferret badgers have been diagnosed north of the gorge.  

Job done, fly home, spend quality time with the wife and kids.  

But not for long. This is the life of someone who chases rabies for a living.  

Thirty six hours later, I’m back out the door for a rabies survey in Uganda.  

For the next two and a half weeks, a team of four CDC personnel and ten local staff spread out across Uganda, from the far eastern border with Kenya to the western border with the Democratic Republic of Congo. In all, more than 1,000 homes were approached and invaluable data were collected to help Congo basin countries refine canine rabies control.  

The high point of the project, however, did not involve dogs, but rather bats. Not just any bat either.  

During a visit to a small village in western Uganda, we were introduced to the EnKunga. These, we were told, are bats “the size of goats” that fly into the mango trees and bite anyone who tries to shoo them away.  

As a veterinarian, I’m fascinated by new or rare animal species. But, as a rabies epidemiologist, I’m concerned about the implications for people’s health. So, while I was somewhat disappointed, I was mostly relieved when my translator arrived and provided the correct translation for “EnKunga”: the gray-cheeked Mangabey monkey.  

But my disappointment highlighted another reality: translation had been a bit of an issue for most of the trip.  

“EnKunga, as interpreted by a 4 year old” by the author’s son, Grant Patton Wallace.

“EnKunga, as interpreted by a 4 year old” by the author’s son, Grant Patton Wallace.

However, once the confusion had resolved, Kikumbe (the true Rutoro word for “bat”) were also reported to plague the villages. These bats reportedly come from caves in Semuliki National Park. Not quite as alarming as man-eating goat-bats, but bats terrorizing villages from caves in a national park is a close second. So, on my only free day off in over five weeks, I headed for Semuliki to investigate the bat caves.  

On arrival, the park rangers were understandably not thrilled about the report of bats coming from their park. They had only seen one species of bat living in the park, and they could be found on the ceiling of the visitor’s center. Even so, a park ranger and I searched the park for suitable bat habitats.

After several hours of stunning park scenery, but no bats, I spotted a giant, hollowed fig tree about a hundred meters off the trail. We bushwhacked to it, did a cursory check for snakes, and then entered. About four feet above our heads, hanging inside the hollowed tree was a small brown mouse chirping at us. We clearly were not welcome.  

Now, I am not a bat expert, but I am a veterinarian and I have conducted several field studies that involved bats. Despite past experience, I was taken by surprise when the small mouse spread its wings and flew toward our heads. This was a bat! And not just any bat, a bat that was different from those that frequent the visitor’s center, and a bat that is most likely a threatened species (Trevor’s Free-tailed bat). The park rangers were very excited by the find, as was I. However, after a day of hiking, we found no bat caves or mass bat gatherings. Most likely, the bats performing nightly raids on the local villages live in small numbers in the trees and come together at night to pester the locals.  

This is a small glimpse into the many worldwide projects that are undertaken by the CDC rabies program.  

In the time that I was conducting work on these three continents, CDC rabies teams were also working in Chile, Ethiopia, Haiti, Peru, Philippines, and the Republic of Georgia.  

World Rabies Day is a time to reflect on the devastation that rabies causes worldwide and the many efforts that public health professionals expend to prevent this disease. It is equally important to remember that there is no such thing as a goat-sized man-eating bat. Also, if anyone knows a good plumber, the bathtub is still leaking, pond pump is still broken, and kitchen sink still smells. Oh, and I heard they might need someone to head to Nepal in the next few days. 

CDC disease ecologist Jeff Doty discusses methods for capturing ferret badgers with a researcher from Pingtung University, Taiwan.

CDC disease ecologist Jeff Doty discusses methods for capturing ferret badgers with a researcher from Pingtung University, Taiwan.

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Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. September 25, 2013 at 11:49 AM ET  -   Liz

    Just so you know, you are a hero. I’m a hairstylist and my client from the Philippines had 2 brothers. Both died of rabies. They think from a village dog or cat that possibly ate an animal in the bush that ha died of rabies. The work you do is invaluable. Rabies is a terrifying disease and if people who lived in the USA realized many folks didn’t have access to even rudimentary health care “maybe” they’d quit watching X-factor and donate a little more.
    Great job and thank you.

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